What Causes Adenomyosis?

If you're looking for relief from pelvic pain, you may need to know what causes adenomyosis. After all, this is a hard-to-diagnose condition, but it could be the cause of your pain. Here's the story.

Adenomyosis is a condition that causes many symptoms—like pelvic pain, bloating, an enlarged uterus, and heavy bleeding—that mimic fibroid symptoms. This condition is the result of endometrial cells (from the uterine inner lining) that migrate into the middle, muscular wall of the uterus, the myometrium, where they stay put. The newly lodged cells then increase the mass of your uterus. And all of these factors trigger symptoms that are also similar to endometriosis. (But adenomyosis and endometriosis are two very different conditions.)

What Causes Adenomyosis?

Unfortunately, we still don’t understand the exact cause of this condition, although different theories exist. One suggests that it’s caused by genetic changes in endometrial cells. Another proposes that, in fact, cells inside your myometrium actually convert into endometrial cells.

In some cases, you may develop adenomyosis if the barrier between your uterus and your endometrial lining sustains damage. You could also develop adenomyosis after sustaining damage to your uterine muscle. (That could happen during a Caesarean section. Or it could be the result of myomectomy surgery to remove fibroids. For that reason, choosing non-surgical fibroid treatments such as UFE may be a safer choice. Especially if you've had a c-section before.)

We also believe that hormones like estrogen trigger the condition since its symptoms go away after menopause. Female levels of estrogen go down in the first year after menopause and the symptoms dissipate as well. And, regardless of the causes, we know that about 1 in 10 women will be affected by this condition. 

How is Adenomyosis Diagnosed?

In the past, adenomyosis was diagnosed after a hysterectomy, when doctors were able to examine the tissue of the removed uterus. Today, the diagnostic process has improved, allowing for detection without this surgery. However, the diagnostic process still isn't perfect.

First, many women wait years to receive an adenomyosis diagnosis symptoms mimic those of other conditions. And because, too often, menstrual symptoms are 'normalized,' that makes it harder for women to self-advocate, meaning they don't get the diagnosis they need. However, when you speak up and begin to seek a diagnosis, you can sometimes detect adenomyosis with a pelvic ultrasound scan. Still, it can be difficult to spot lodged cells on an ultrasound, so an MRI is often needed for confirmation. Often, adenomyosis is detected while your doctor is screening for fibroid tumors.

What Are the Symptoms of Adenomyosis?

While a good portion of women—as many as 30%--won’t experience any symptoms, women with adenomyosis typically experience:

• Heavy bleeding
• Intense pelvic pain and pressure
• Cramping
• Pain that radiates to your legs and back
• Distended stomach
• Blood clots in the pelvis and legs
• Prolonged menstrual cycles
• Spotting between cycles.There's one more important symptom that you need to know about: adenomyosis can impact your fertility. This is especially true if you're attempting to get pregnant through IVF (In-vitro fertilization.) That's because adenomyosis can interfere with embryo implantation. And, if you do become pregnant, it can also increase your risk of miscarrying.

How do we Treat Adenomyosis?

The only way to cure this condition is to undergo a hysterectomy. For many women, this will be too drastic an option—especially since we now know that hysterectomies leave women at risk for cardiac and metabolic problems.

So, while we can’t stop the problem without removing your uterus, we can help manage symptoms with less invasive treatment options. The best option for you will depend on the severity of your symptoms and your overall health:

1. Anti-inflammatory medications like ibuprofen can help with the pain and reduce the blood flow. For best results, start taking medication several days prior to the start of your cycle.
2. Taking birth control pills and other hormonal supplements can help manage the condition.
3. Endometrial Ablation is a minimally invasive procedure that destroys the uterine lining, so no cells can migrate into the muscle wall. The success of this option will depend on how deeply endometrial tissue has penetrated into the wall of your uterus.
4. UAE or Uterine Artery Embolization. We use this technique commonly used to treat uterine fibroids, but it can help adenomyosis, too. Here, we inject particles into the uterine artery, blocking blood flow to the problem area. We do this to deprive your tissue of blood and oxygen, helping stop adenomyosis' progression. But, unlike UFE for fibroid treatments, when you have UAE for adenomyosis, you have to spend the night in the hospital. As we evolve our technique, UAE has earned an 80% effectiveness rating in abating the symptoms of adenomyosis, making it an excellent short term solution to this painful condition.

Are you living with adenomyosis and need pain relief? Click here to request an appointment with our Houston area specialists today. We are here to help you get back to a pain-free life!

Sources: Journal of Clinical and Experimental Reproductive Medicine